R1 Endoscopic papillectomy for adenocarcinoma: is complementary pancreatoduodenectomy unavoidable?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Oncology

Background:

• Limited research exists on oncological outcomes of complementary pancreatoduodenectomy (PD) after incomplete (R1) endoscopic papillectomy (EP) for early-stage ampullary adenocarcinoma (AA).
• Increasing use of endoscopic approaches and inherent risks of PD necessitate evaluating outcomes of complementary PD following EP R1 for AA.

Purpose of the Study:

• To assess and compare short- and long-term oncological outcomes, morbidity, and mortality rates in patients undergoing complementary PD after EP R1 for AA.
• To compare survival rates (overall and disease-free) between EP R1 and EP+PD groups.
• To compare morbidity and mortality rates between EP+PD and upfront PD (uPD) groups.

Main Methods:

• Retrospective comparison of four patient groups between January 2010 and December 2022: EP R0, EP R1, EP+PD, and uPD.
• Primary endpoints included differences in overall survival (OS) and disease-free survival (DFS) between EP R1 and EP+PD groups.
• Secondary endpoints involved comparing morbidity and mortality rates between EP+PD and uPD groups.

Main Results:

• In the EP cohort, intraluminal hemorrhage was the major complication (29%).
• Biliary obstruction signs were significantly higher in the EP R1 group compared to the EP R0 group.
• Postoperative outcomes and survival rates (OS and DFS) were similar between the EP+PD and uPD groups, with no significant difference in long-term outcomes.

Conclusions:

• Complementary PD following R1 EP for AA does not increase postoperative complications or mortality.
• Complementary PD after R1 EP does not offer improved long-term oncological outcomes compared to upfront PD.